Laser Assisted In-Situ Keratomileusis (LASIK) is currently the most common elective surgical procedure in the world with over one million people having LASIK each year. Although very popular and safe by surgical standards, LASIK is not for everybody. It is important to understand the advantages and limitations of LASIK and to select a qualified doctor to be assured of the highest probability of a desired outcome.
What is LASIK?
LASIK is a two-step process to change the way light will focus at the back of your eye by changing the shape of the cornea. The first step of LASIK is to use a laser or mechanical microkeratome to create a flap of corneal tissue. This flap is moved out of the way, and then excimer laser energy is applied to the treatment area to remove tissue. After the treatment is finished, the flap is returned to its original position over the treatment area.
Why would I want LASIK?
When you are myopic (nearsighted) light entering your eye will focus in front of the retina at the back of the eye. When you are hyperopic (farsighted), light entering the eye will focus behind the retina. When you have astigmatism, the cornea is not spherical like the top of a ball, but is elliptical like the back of a spoon. Astigmatism will cause some light to focus at the retina, some off center, some in front of the retina, and/or some light will focus behind the retina. Corrective lenses like spectacles and contact lenses can correct myopia, hyperopia, and astigmatism. LASIK may provide the convenience of a reduced need for corrective lenses.
LASIK will not correct presbyopia. For most people, presbyopia occurs after age 40 when the natural lens of the eye is no longer able to change focus from distant to near and most people need reading glasses or bifocals. LASIK cannot correct diseases of the eye, lazy eye, or other problems that are not related to myopia, hyperopia, or astigmatism.
Does LASIK hurt and how long before I can see?
Pain is rare with LASIK, although some patients will experience some discomfort. For many patients, vision clarity will be almost immediate, although it is common for fluctuation in vision and temporary dry eye during the normal six-month healing period. Medications will be required and some will use artificial tears to combat dryness.
Why would I not want LASIK?
With all surgery, there is risk. LASIK is no exception. Even with a high rate of happy patients, some will not receive the desired result. Determining if you are at an unusually high risk for a poor outcome is one of the most valuable services a qualified doctor can provide. This is one of the reasons surgeon selection is very important. You and a qualified doctor need to discuss all the relevant risks and consequences of LASIK based upon your unique circumstances.
Is LASIK permanent?
Yes…and no. The changes made by LASIK are permanent, but the eye will continue to change at the same rate it did before surgery. You may eventually need glasses again, or additional LASIK treatment. This is an important issue to discuss with your doctor.
Is there anything I can’t do after LASIK that I could do before LASIK?
A successful LASIK will not limit the activities of most adults. People with LASIK swim, climb mountains, water ski, sky dive, SCUBA dive, and participate in other strenuous activity without difficulty. Professional athletes and people in the military, police, and fire fighters have had LASIK. What may be different is if you have an injury to your eye. Remember that once you have had LASIK you have always had LASIK. If you suffer trauma to the eye, it is a good idea to be evaluated by a eye surgeon as well as a general physician.
Is LASIK the only laser eye surgery?
LASIK has some very real limitations that make it inappropriate in some circumstances. It may be that a different type of surgery is more appropriate than LASIK. If you have unusually thin corneas or only slightly poor eyesight, it may be that laser eye surgery without the LASIK flap will better. If you are young and have very poor vision, an artificial lens implanted in front of your natural lens may be more appropriate. If you are older and have very poor vision, an artificial lens that replaces your natural lens may be best. It is possible that no eye surgery would be appropriate. When discussing surgery with your doctor, keep your mind open.
A friend had LASIK and is thrilled. Should I use that doctor?
Perhaps you should, but perhaps you should not. Discussing the experience of LASIK with someone is a wonderful way to lean what it is like to have LASIK, but it is a poor way to determine if that person’s doctor is best for you. Every individual is different and different combinations of technique and technology are needed to best serve the individual. Would you use your friend’s glasses? Probably not. Consider the selection of your surgeon as unique as an individual set of glasses.